Administration and Policy in Mental Health and Mental Health Services Research最新文献

A quarter of US adults face mental health challenges, yet less than half receive treatment, partly due to therapist shortages. Scaling trained paraprofessionals to provide effective care could address this gap. We evaluated the impact of evidence-based coaching within a real-world blended care digital mental health platform. 266 working adults (62% women, M_age=33 years, 40% people of color) newly enrolled (2021–2022) in the platform (Modern Health) completed surveys at baseline and 3-months. Participants primarily engaged with certified professional coaches and could also access therapy and digital resources. We examined pre-post changes in outcomes and differences by baseline clinical status. Participants used an average of 2.5 coaching sessions and improved in distress tolerance (+ 4.1%), perceived stress (-8.4%), self-compassion (+ 5.9%), and mindfulness (+ 2.6%) (ps < 0.01). Although elevated risk users (vs. lower risk) reported descriptively greater improvements in distress tolerance (+ 4.7% vs. +3.7%), perceived stress (-10% vs. -3.7%), self-compassion (+ 7.6% vs. +5.2%), and mindfulness (+ 3.3% vs. +2.1%), these differences were not statistically significant (ps > 0.05). Depression (-22.5%) and anxiety (-12%) improved (ps < 0.001), with elevated risk users reporting greater reductions (b=-3.15, p < .001 for depression; b=-2.61, p < .001 for anxiety). Among elevated risk users, 71.7% improved or recovered from depression or anxiety and 96.1% of lower risk users maintained lower depression and anxiety. Technology-enabled coaching, as part of a blended care platform, improved depression, anxiety, and transdiagnostic emotional processes. Participants with higher baseline depression and anxiety reported greater improvements, highlighting coaching’s effectiveness for people with elevated needs. By redefining care and leveraging technology, coaching may be a scalable treatment solution.

Parental substance use represents a significant source of family separation in the U.S. child welfare system. Family-focused substance use treatment programs are an innovative approach to keeping families safely together while addressing the impacts of parental substance use on children and the family system. Yet, we know very little about how families experience this new type of treatment, particularly as it relates to trauma-informed care (TIC). This qualitative study examines the experience of 24 parents participating in the In-Home Recovery Program (IHRP), an intervention that provides substance use and early child relational health treatment to families at risk of separation in the child welfare system. A content analysis indicated that IHRP was highly valued by families. The majority of participants experienced the intervention as uniquely helpful and supportive compared to other forms of substance use treatment they had previously received. Results suggest that IHRP is a model that operationalizes principles of TIC and which could be expanded as a supportive approach to parental substance use in the child welfare system to prevent family separation.

Surging rates in child internalizing problems require teachers to serve as frontline responders, especially in marginalized urban communities where structural barriers constrain access to healthcare resources. The current mixed methods study examined teachers’ use and perceptions of tools for addressing anxiety in urban elementary schools serving predominately low-income and Black and Hispanic youth. Across surveys (N = 82) and interviews (n = 12), teachers were asked about their current practices, their perceptions of the most common evidence-based practice elements for youth anxiety, and their preferences for professional development (PD) materials going forward. All teachers endorsed use of evidence-based practices for anxiety. Among the practices assessed, teachers were most enthusiastic about using modeling, praise/rewards, cognitive coping, and relaxation strategies, and were least enthusiastic about exposure, self-monitoring, and psychoeducation. In interviews, teachers noted key facilitators (e.g., keeping strategies time-limited), and highlighted other “setting up for success” strategies (e.g., building relationships with students) that work to minimize anxiety in classrooms. Teachers with higher self-efficacy and sense of personal accomplishment perceived evidence-based practices for student anxiety as more usable, underscoring the importance of teachers’ job-related wellness in student mental health promotion. Teachers preferred PD materials that were time-limited, asynchronous, and engaging. Taken together, findings indicate that many teachers are already incorporating evidence-based anxiety practices into their routines. Results inform policy and practice recommendations, and suggest value in leveraging teachers’ existing practices and opinions to develop relevant PD materials that optimize practices for addressing child anxiety in urban schools.

Schools are a key setting where services to support youth mental health can occur, and teachers are important for students’ social, emotional and behavioral well-being. Teacher-delivered mental health prevention and intervention programs offer an opportunity to integrate mental health support meaningfully into students’ everyday lives, as well as expand the reach and impact of mental health services. This is particularly important given the lack of highly trained mental health providers and the barriers to accessing clinical services. However, teachers are not trained as mental health providers and serve a primarily educational mission, and therefore, there are unique considerations for conceptualizing teachers as individuals who can deliver mental health prevention and intervention programs. The purpose of this paper is to delineate conceptual and practical issues related to utilizing teachers as non-traditional mental health providers including key opportunities and challenges to teacher-delivered mental health interventions. We present four examples of teacher-delivered programs that aim to support student mental health and well-being and use these example programs to illustrate these key opportunities and challenges. We also outline directions for future research, with the ultimate goal of enhancing teachers’ skills and improving youth mental health.

Mental health task sharing, which involves delegating select mental health tasks to non-licensed providers in social service settings, has been used globally and in the U.S. to improve access to and uptake of mental health care. This study aimed to identify barriers and facilitators to effective implementation of mental health task sharing in community-based organizations mainly serving older Chinese adults, a fast-growing older immigrant population with a high prevalence of unmet mental health needs. Semi-structured interviews were conducted in 2023 with 30 service providers from 17 community-based social service organizations in New York City that had implemented mental health task-sharing initiatives since 2016. Interview data were analyzed by two coders using the framework method, a systematic approach for managing and interpreting qualitative data through coding, charting, and thematic analysis, with codes reflecting key domains in the Consolidated Framework for Implementation Research (CFIR). Codes were further analyzed for the factors’ positive or negative influence on implementation. Key barriers to the implementation of mental health task sharing included limited mental health resources, varying levels of staff mental health competencies, and insufficient financial incentives for social service organizations to provide mental health care. Facilitators to mental health task sharing implementation included supportive leadership, training, cross-system collaborations between mental health specialists and social service providers, and close teamwork between administrators and frontline providers in social service organizations. Study findings highlight the importance of more systematically integrating mental health and social care and of using culturally tailored strategies to engage different populations in care.

To improve access to mental health care for children and adolescents, it is necessary to identify the barriers faced by their caregivers. The aim of this study is to identify these barriers in Greece and to investigate the reliability and validity of the modified version of the Barriers to Access to Care Evaluation scale (BACE) - the BACE Proxy Report (BACE-PR). A total of 265 caregivers who reported that their offspring had mental health difficulties completed the BACE-PR. Descriptive statistics were used to identify the major barriers to accessing care. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to investigate the factor structure of the instrument. Item parameters were assessed via Item Response Theory. Interpretability was assessed by linking summed scores to IRT-based scores. Caregivers reported care costs, their willingness to resolve problems on their own, and their own concern that their children might be seen as weak, as the major barriers to services access. Obsessive compulsive symptoms and self-harm were the conditions for which caregivers reported the highest level of barriers. EFA and CFA suggested that a one-factor solution fit the data well (RMSEA = 0.048, CFI = 0.991, TLI = 0.990). Internal consistency was found to be high (ω = 0.96). Average z-scores provided five meaningful levels of caregivers’ perceived barriers compared to the national average. Caregivers face a variety of barriers to access mental health care for their children, and this could partly explain the treatment gap in the Greek mental health sector. Our study provides evidence for the reliability and validity of the BACE-PR scale, which can aid to identify caregiver-perceived barriers and to design interventions to improve access to mental health care.